Attention Deficit Hyperactivity Disorder (ADHD)

Introduction

The Questions and Answers that follow aim to provide an introduction to Attention Deficit Hyperactivity Disorder (ADHD) for parents and other family members. Following those, we offer links to selected resources for more information and support and a list of valuable services.
Note that we use the term doctor to refer to physicians, nurse practitioners, physician assistants, and other licensed clinicians who may care for your child.
More information about many topics relevant to children with ADHD and many other chronic conditions and their families can be found in the left menu. Detailed information aimed at primary care doctors can be found in our Attention-Deficit/Hyperactivity Disorder (ADHD) module.

What is ADHD?

ADHD typically begins in childhood (usually identified between 4 and 18 years of age) and involves some combination of hyperactivity, impulsivity, and/or inattention. Three types of ADHD have been defined: predominantly inattentive, predominantly hyperactive/impulsive, and a combination of those two.

How do you get ADHD?

While ADHD tends to run in families, and studies of twins and adopted children support a strong genetic component, the genetics are not well understood. A child's environment also plays a role in some cases of ADHD. Many other things can cause ADHD-like symptoms, such as stress, lack of sleep, anxiety, depression, poor nutrition, a history of trauma, medication side effects, and other medical problems.

What are the symptoms?

Toddlers with the hyperactive/impulsive type of ADHD may be constantly physically active, running in circles, and climbing on furniture, while adolescents with this type may engage in risky behaviors and sports. Preschoolers with the inattentive type may have difficulty paying attention while reading a picture book, while adolescents may find it hard to finish homework and perform required tasks.
Many children with ADHD will be able to concentrate on their favorite activities for long periods, such as playing video games for hours, but have a hard time concentrating on tasks they need to do, such as homework. Teachers are often a good resource to help families recognize if the child is struggling with activity level, impulse control, or distractibility more than peers.

How is it diagnosed?

Most children with ADHD are diagnosed and managed within the medical home by the child’s pediatrician or family doctor. Children with problematic levels of inattention, hyperactivity, or impulsivity, low school achievement for the child's IQ, and/or behavior problems should be evaluated. This will generally take a few visits and require gathering information about school performance, school/daycare behavior, functioning within the family and with friends, and other medical or mental health concerns. Evidence of functional problems in at least two settings (usually at home and at school) are needed to make the diagnosis. If the child only struggles in one setting, it likely isn’t ADHD. Developmental delays, low IQ, or other chronic problems such as sensory deficits, other behavioral health or psychosocial problems, and/or features of autism make it harder to diagnose ADHD.
More information about diagnosing ADHD can be found at Symptoms and Diagnosis of ADHD (CDC) and The ADHD Diagnostic Process. Guidelines for diagnosis, published by the American Academy of Pediatrics (AAP), can be found at [Wolraich: 2019].

What is the expected outcome?

ADHD is a life-long condition. However, most children learn skills to help manage their symptoms and play to their strengths. Not all children or adults will need medication to manage ADHD..

Will anyone else in the family get ADHD?

ADHD tends to run in families; the parents and the primary care doctor should be aware of this possibility in siblings

What is the treatment?

Stimulant medications are currently considered the most effective treatment for ADHD symptoms. A variety of other medications may be considered, especially if stimulants have too many side effects or don’t work well enough. Behavior therapy (also called behavior modification or psychosocial treatment) is the most effective non-medication therapy for children. Behavior therapy may include helping parents and teachers to improve structure and communication.
Occupational therapy can help children manage executive function skills, like organizing and planning, that will help them be more successful at school and home. An occupational therapist may be found through the school system, or the child can be referred to private occupational therapy. There are some newer treatments including game- and virtual reality-based options now available for certain children, however, these are rarely covered by insurance or Medicaid.

How will my family’s life be changed?

While a child’s diagnosis with ADHD may greatly affect the family, there are many treatments available. ADHD symptoms and related behaviors can be managed to help the child lead a normal and productive life. Effective management of ADHD can really improve quality of life for the child and her family and community.
In one study, parents of children with ADHD reported a major impact on parent emotional health and family functioning. [Klassen: 2004] Children with ADHD are more likely to have a hard time making friends and participating in group activities. They may also have a harder time learning to take care of themselves, needing frequent reminders and supports. Children with ADHD may often develop anxiety and/or depression and are more likely to have conduct disorder and substance abuse as teenagers, especially if untreated or undertreated as children. [Klassen: 2004] [Wilens: 2008] [Pliszka: 2007] [Klassen: 2004]

I don't want to get my child addicted to drugs by starting him on stimulants.

Children with ADHD rarely get addicted to (or dependent upon) stimulants and evidence suggests that careful use of stimulants in the early years decreases risk of adolescent drug use and cigarette smoking. The reasons are not well understood, but one study found that reduced self-esteem due to school problems and impulsivity may contribute to drug use among children who are not treated for their ADHD. [Wilens: 2008] Another study suggests that stimulant use for ADHD does not affect later illicit substance abuse. [Shaw: 2012]

I have heard that stimulants are associated with heart problems. Is there another safer remedy such as a diet that will help my child?

Research to date has not clearly shown a higher risk of serious heart problems in children using stimulant medication. [Wolraich: 2019] Behavioral therapy is an important part of the management of ADHD but, for many children, is not enough to manage their symptoms. The risk of heart problems with stimulants, which are the most common class of medication used to treat ADHD, is very small. The medical home doctor should talk with you about specific concerns based on your child and family’s health history.

How long will my child need to be on medication?

ADHD medications do not cure ADHD; they help manage the symptoms of ADHD. Those symptoms will improve over time in most people, but some will continue to benefit from medication even in adulthood. The length of treatment will depend on the child and whether she has associated learning problems. Your primary care doctor will regularly check progress to determine with you and your child when to consider stopping medication.

I've heard about medication holidays. What does that mean?

You, your child, and your primary care doctor can discuss if there are times that stimulants are not needed (such as prolonged school holidays or even weekends). This would not apply to children on atomoxetine (Strattera) or extended-release preparations of guanfacine and clonidine.

What are side effects of stimulant medications?

Common side effects are: decreased appetite, insomnia, anxiety or nervousness, stomachache or headache, increased heart rate and blood pressure, and irritability (most often as the medication wears off in the afternoon/evening). Often, raising the dose slowly over time can avoid many of these side effects. Adding a small dose in the afternoon can sometimes get rid of irritability. Since one stimulant may work better than another for your child, try a different kind before giving up.

Will my child be shorter if he takes stimulants?

While stimulants can lead to weight loss in some children, this doesn’t happen in all children (some even gain weight). Stimulants may slow height growth for a while, but then kids generally catch up over time. Some studies have shown a slight decrease in projected height with long-term stimulant use, but more research is needed to confirm this finding. [Harstad: 2014] [Troksa: 2019] Your primary care doctor will track weight and height before, during, and after stimulant use to identify any concerns about growth while your child is growing.

Why doesn’t my insurance cover behavior therapy for ADHD?

Many insurers cover stimulant medications for children with ADHD because they are the most effective treatment for ADHD symptoms. Insurers may cover behavior therapy for related conditions such as depression, substance abuse, or anger management. Some behavioral approaches can be provided through the public school system, such as social skills training, depending on the availability of skilled staff and the needs of the child. Insurers may cover occupational therapy to work on executive function skills, organization, and fine motor skills like writing.

Resources

Information & Support

For Parents and Patients

Support

Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD)
A national non-profit organization, with numerous local chapters, that provides education, advocacy, and support for ADHD; includes ADHD-focused e-learning trainings for parents and teachers, information, advocacy, and support, podcasts, newsletters, and more.

Understood for Learning & Attention Issues
An organization providing resources to young adults, parents, and teachers of children with different learning styles and attention disorders. Focusses on an initiative to create inclusive workplaces by developing and implementing best-in-class disability inclusion programs so they can hire, advance, and retain people with disabilities.

General

ADHD (MedlinePlus)
Provides links to high-quality sources of information about ADHD; a service of the National Library of Medicine and National Institutes of Health.

What is ADHD? (KidsHealth)
Health information for parents, kids, and teens. This is the parent's page on ADHD, see the tabs at the top for the pages focused on kids and teens; sponsored by Nemours Foundation.

The Diet Factor in ADHD (AAP)
A comprehensive overview of the role of dietary methods for treatment of children with ADHD when pharmacotherapy has proven unsatisfactory or unacceptable; American Academy of Pediatrics.

ADHD Information (AAP)
List of publications for parents of children with ADHD; American Academy of Pediatrics.

Patient Education

Where can I go for further information?

Books for Children:
  • Otto Learns about His Medicine: A Story About Medication for Children With ADHD [Galvin: 2001]
  • Being in Control: Natural Techniques for Increasing Your Potential and Creativity for Success in School [Alster: 2001]
  • Eagle Eyes: A Child's Guide to Paying Attention (The Coping Series) [Gehret: 2009]
  • Jumpin' Johnny Get Back to Work: A Child's Guide to Adhd-Hyperactivity [Gordon: 1993]
  • Shelley, the Hyperactive Turtle [Moss: 1989]
  • Learning to Slow Down and Pay Attention [Nadeau: 2004]
  • Putting on the Brakes: Understanding and Taking Control of Your ADD or ADHD [Quinn: 2009]
  • Cory Stories: A Kid’s Book About Living with ADHD [Kraus: 2004]
  • The Adventures of Phoebe Flower: Stories of a Girl with ADHD [Roberts: 2010]
  • The Survival Guide for Kids with ADHD [Taylor: 2012]
Although the books aren’t about ADHD, the popular young adult Percy Jackson series by Rick Riordan features young heroes who all have ADHD. [Riordan: 2014]

Books for Parents:
  • Smart but Scattered [Dawson: 2009]
  • ADHD: What Every Parent Needs to Know (2nd ed.) [Reiff: 2011]
  • Taking Charge of ADHD (3rd ed.) [Barkley: 2013]
  • You and Your A.D.D. Child: How to Understand and Help Kids With Attention Deficit Disorder [Warren: 1995]
See Books for Adults, Teens, Children: NRC Staff Favorites (National Resource Center on ADHD) for more titles.

ADHD Information (NIMH)
Overview and links to more information from the National Institute of Mental Health

ADHD: Parents' Medication Guide (AACAP) (PDF Document 1.1 MB)
Forty-five page booklet that helps youngsters and their families better understand the treatments for ADHD; prepared by the American Academy of Child & Adolescent Psychiatry and American Psychiatric Association (2013).

Services for Patients & Families in Utah (UT)

For services not listed above, browse our Services categories or search our database.

* number of provider listings may vary by how states categorize services, whether providers are listed by organization or individual, how services are organized in the state, and other factors; Nationwide (NW) providers are generally limited to web-based services, provider locator services, and organizations that serve children from across the nation.

Studies

Clinical Trials in ADHD (clinicaltrials.gov)
Trial listings for ADHD with "completed," "recruiting," and "active" status noted.

Mental Health Clinical Trials (NIMH)
Links to descriptions of clinical trials related to numerous mental health conditions, including ADHD, anxiety, and depression; National Institute of Mental Health.

Authors & Reviewers

Initial publication: March 2012; last update/revision: November 2020
Current Authors and Reviewers:
Author: Lynne M. Kerr, MD, PhD
Reviewer: Jennifer Goldman-Luthy, MD, MRP, FAAP
Funding: The Medical Home Portal thanks the 2011-2012 URLEND Medical Home Portal trainees group for their contribution to this page.
Authoring history
2015: first version: Jennifer Goldman-Luthy, MD, MRP, FAAPR; Robyn Nolan, MDR
AAuthor; CAContributing Author; SASenior Author; RReviewer

Page Bibliography

Alster JM.
Being in Control: Natural Techniques for Increasing Your Potential and Creativity for Success in School (Paperback).
Rainbow Cloud; 2001. 9659025114

Barkley R.
Taking Charge of ADHD .
Third Edition ed. The Guilford Press; 2013. 978-1462507894 http://www.amazon.com/Taking-Charge-ADHD-Third-Authoritative/dp/146250...

Dawson P.
Smart but scattered.
Guilford Press; 2009. 978-1593854454 http://www.amazon.com/Smart-but-Scattered-Revolutionary-Executive/dp/1...

Galvin M.
Otto Learns About His Medicine: A Story About Medication for Children With ADHD.
3rd ed. Washington DC: Magination Press; 2001. 1557987726 http://www.apa.org/pubs/magination/4417726.aspx
Otto, a fidgety young car, has trouble paying attention in school, has trouble remembering important information, and is unable to listen long enough to learn how to drive. Otto and his parents visit a special mechanic who explains about "car medicine" that can help him control his behavior. This delightful story addresses the concerns felt by children who have been prescribed drugs to reduce hyperactive behavior.

Gehret Jeanne, LaDuca Michael.
Eagle Eyes: A Child's Guide to Paying Attention (The Coping Series) (Hardcover).
Revised ed. Verbal Images Press; 2009.

Gordon M.
Jumpin' Johnny Get Back to Work: A Child's Guide to Adhd-Hyperactivity (Paperback).
Gsi Publications; 1993. 9780962770142

Harstad EB, Weaver AL, Katusic SK, Colligan RC, Kumar S, Chan E, Voigt RG, Barbaresi WJ.
ADHD, stimulant treatment, and growth: a longitudinal study.
Pediatrics. 2014;134(4):e935-44. PubMed abstract / Full Text

Klassen AF, Miller A, Fine S.
Health-related quality of life in children and adolescents who have a diagnosis of attention-deficit/hyperactivity disorder.
Pediatrics. 2004;114(5):e541-7. PubMed abstract

Kraus J.
Cory stories: a kid's book about living with Adhd.
Magination Press; 2004. 978-1591471547 http://www.amazon.com/Cory-Stories-Kids-About-Living/dp/1591471540

Moss DM.
Shelley, the Hyperactive Turtle (Special Needs Collection) (Hardcover).
Woodbine House; 1989. 9780933149311

Nadeau K.
Learning to Slow Down and Pay Attention.
3rd ed. Magination Press; 2004. 978-1591471554 http://www.amazon.com/Learning-Slow-Down-Pay-Attention/dp/1591471559

Pliszka S.
Practice parameter for the assessment and treatment of children and adolescents with attention-deficit/hyperactivity disorder.
J Am Acad Child Adolesc Psychiatry. 2007;46(7):894-921. PubMed abstract
Historical ADHD guideline from 2007.

Quinn PO, Stern JM, Lee J.
Putting on the Brakes: Understanding and Taking Control of Your ADD or ADHD.
2nd Edition ed. Magination Press; 2009. 978-1-4338-0441-0

Reiff M.
ADHD: What Every Parent Needs to Know .
2nd ed. American Academy of Pediatrics; 2011. 978-1581104516 http://www.amazon.com/ADHD-What-Every-Parent-Needs/dp/1581104510

Riordan R.
Percy jackson and the olympians.
Disney-Hyperion; 2014. 978-1484707234 http://www.amazon.com/Jackson-Olympians-Paperback-covers-poster/dp/148...

Roberts B.
The adventures of phoebe flower: stories of a girl with Adhd.
Advantage Books; 2010. 978-0971460966 http://www.amazon.com/Adventures-Phoebe-Flower-Stories-Girl/dp/0971460...

Shaw M, Hodgkins P, Caci H, Young S, Kahle J, Woods AG, Arnold LE.
A systematic review and analysis of long-term outcomes in attention deficit hyperactivity disorder: effects of treatment and non-treatment.
BMC Med. 2012;10:99. PubMed abstract / Full Text

Taylor J.
Survival guide for kids with Adhd .
ReadHowYouWant; 2012. 978-1442996823 http://www.amazon.com/The-Survival-Guide-Kids-ADHD/dp/144299682X

Troksa K, Kovacich N, Moro M, Chavez B.
Impact of Central Nervous System Stimulant Medication Use on Growth in Pediatric Populations with Attention-Deficit/Hyperactivity Disorder: A Review.
Pharmacotherapy. 2019;39(6):665-676. PubMed abstract
This article review the newer data surrounding the effects of central nervous system stimulants on growth parameters in children with ADHD.

Warren P, Capeheart J.
You and Your A.D.D. Child: How to Understand and Help Kids With Attention Deficit Disorder (Paperback).
Nelson Books; 1995. 0785278958

Wilens TE, Adamson J, Monuteaux MC, Faraone SV, Schillinger M, Westerberg D, Biederman J.
Effect of prior stimulant treatment for attention-deficit/hyperactivity disorder on subsequent risk for cigarette smoking and alcohol and drug use disorders in adolescents.
Arch Pediatr Adolesc Med. 2008;162(10):916-21. PubMed abstract / Full Text

Wolraich ML, Hagan JF Jr, Allan C, Chan E, Davison D, Earls M, Evans SW, Flinn SK, Froehlich T, Frost J, Holbrook JR, Lehmann CU, Lessin HR, Okechukwu K, Pierce KL, Winner JD, Zurhellen W.
Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents.
Pediatrics. 2019;144(4). PubMed abstract / Full Text
This guideline revision provides incremental updates to the 2011 guideline on ADHD, including the addition of a key action statement related to diagnosis and treatment of comorbid conditions in children and adolescents with ADHD. The accompanying process of care algorithm has also been updated to assist in implementing the guideline recommendations; American Academy of Pediatrics (AAP).